Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2019; 25(42): 6354-6364
Published online Nov 14, 2019. doi: 10.3748/wjg.v25.i42.6354
Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study
Jooyoung Lee, Jong Pil Im, Kyungdo Han, Seona Park, Hosim Soh, Kukhwan Choi, Jihye Kim, Jaeyoung Chun, Joo Sung Kim
Jooyoung Lee, Joo Sung Kim, Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea
Jooyoung Lee, Jong Pil Im, Seona Park, Hosim Soh, Kukhwan Choi, Joo Sung Kim, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Kyungdo Han, Department of Biostatics, College of Medicine, Catholic University of Korea, Seoul 06591, South Korea
Jihye Kim, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul 06135, South Korea
Jaeyoung Chun, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Author contributions: Lee J, Han KD and Im JP design the research; Han KD, Park S, Soh H, and Choi K contributed in data acquisition; Lee J and Han KD contributed in data analysis and interpretation; Lee J and Im JP drafted the manuscript; Kim J, Chun J and Kim JS critically revised the manuscript; All authors approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Seoul National University Hospital Institutional Review Board (H-1703-107-840).
Informed consent statement: All personal information was encrypted and all data were anonymous. And informed consent was waived by the Seoul National University Hospital Institutional Review Board because of retrospective study design.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jong Pil Im, MD, PhD, Professor, Doctor, Department of Internal Medicine and Liver Research Instititute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul 03080, South Korea.
Telephone: +82-2-20720638
Received: July 2, 2019
Peer-review started: July 2, 2019
First decision: August 2, 2019
Revised: September 18, 2019
Accepted: October 17, 2019
Article in press: October 17, 2019
Published online: November 14, 2019

There is a growing evidence regarding an increased risk of inflammatory bowel disease (IBD) among patients with airway diseases.


To investigate the influence of chronic obstructive pulmonary disease (COPD) on the risk of IBD.


A nationwide, population-based study was conducted using data from the National Health Insurance Service database. A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified. The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria. The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models. The cumulative incidences of IBD were compared between the groups.


The COPD group had higher incidences of IBD compared to non-COPD controls (incidence rate, 9.98 vs 7.18 per 100000 person-years, P < 0.001). The risk of IBD in the COPD group was increased by 1.38 (adjusted hazard ratio (HR); 95%CI: 1.25-1.52). The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group (12.39 vs 9.77 per 100000 person-year, P < 0.001). The severity of COPD was associated with an increased risk of IBD (adjusted HR 1.70 in severe COPD, 95%CI: 1.27-2.21 and adjusted HR 1.35 in mild COPD, 95%CI: 1.22-1.49)


The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

Keywords: Claim data, Inflammatory bowel disease, Chronic obstructive pulmonary disease, Crohn’s disease, Ulcerative colitis

Core tip: In this nationwide population-based study, we showed that the incidence of inflammatory bowel disease (IBD) was higher in chronic obstructive pulmonary disease (COPD) patients compared to age-and sex-matched controls without IBD in South Korea. And the risk of developing IBD also increased as the severity of COPD increased. It is important to be aware of the gastrointestinal symptoms indicative of IBD in COPD patients. Accurate clinical assessment should be done, especially in patients with severe COPD in order to prevent complications and avoid excess medical expenses.